11.5.9_Hydrant_Application.doc

Hydrant Use Application

Organization: ____________________________________________________

Mailing Address: ___________________________________________________________________ Office Phone: _____________________________ Cell Phone: _____________________________

Hydrant Number: ______________Location:________________________________________ Hydrant Meter #: _________________ Beginning Meter Reading (gallons): _____________ Scheduled Start Date: ____________________ Scheduled Finish Date: ______________________ ____ Backflow Preventer Will Be Used ____ Shutoff Valve Will Be Used

Proposed Use of Hydrant Water: _______________________________________________________

Note!! Use only fire hydrant wrenches on the caps or operating nut. No pipe wrenches. Open hydrant valve all to way to establish flow and prevent possible valve damage. Turn hydrant valve completely off at the end of each work day to allow the hydrant to drain and prevent freezing. Contractor WILL be charged for any hydrant valve damage they cause. Call 719-491-2982 or email vincent.e.guthrie2.civ@mail.mil with your meter reading by the 15TH of each month.

Call the Fort Carson Dig Permit Office at (719) 302-0157 to obtain a work clearance/dig permit if any digging or excavation will be done. Fort Carson requires that a backflow preventer and shutoff valve be used at the connection point to the fire hydrant. Hydrants may be used for essential purposes only. Essential uses include, but are not limited to, dust mitigation, compaction, and construction site water use. Do not allow water to pool or flow onto the pavement or into gutters/storm sewers. Repair any system breaks and leaks immediately. Submit application to:

Fort Carson Directorate of Public Works Building 1219, Room 209 Phone: Vince Guthrie 719-526-2927 or 719-491-2982 M-F 0730 – 1600 hours Name

Signature

Date

For Office Use Only

Permit Issued: No (see attached explanation) _____ Yes _____ Based on the information provided, a permit is issued authorizing the use of the requested hydrant. Call 719-491-2982 with the final meter reading from the hydrant. Keep a copy of this permit near the hydrant location, in your water truck(s), and/or in your construction trailer.

This permit will expire _______________ day of __________________, 201____.

DPW approval by _____________________________________________________